An E l e m e n ta l and D e n ta l
L i t e r at u r e
Ilana Ickow
D
entistry has been practiced for thousands of years.
The ancient Chinese developed toothbrushes from
boar bristles, and the Etruscans of ancient Italy carved
false teeth from ivory. Remains of primitive humans
have been discovered with indentations in their teeth, presumably
caused by toothpicks and an early form of dental floss [1].
In addition to such evidence and secular historical reports,
throughout the generations of the Tanach, Mishnah, and Talmud,
until the Rishonim and Acharonim, Judaic literature has discussed
dentistry and has given significant insight into its advancement
through the ages.
In Tanach, the word “shen,” “tooth,” is cited 42 times. The
first dental mention in the Torah refers to personal appearance
and occurs in Bereishis (49:12), when Yaakov blessed Yehuda, “u’liven
shinayim m’chalav.” Yaakov wished nourishment and plenty upon
Yehuda by blessing him with teeth whiter than milk. The Torah
also mentions teeth in the context of the judicial system, while
referring to financial compensation in the words, “shen tachas shen,”
“a tooth for a tooth” (Shemos 21:24, Vayikra 24:20). The physi-
cal reaction of teeth to food is described in Yirmiyahu (31:29),
“kol ha’adam ha’ochel haboser tikhena shinav,” “any person who eats
sour grapes, his teeth are set on edge.” Most references to teeth
in Tanach, however, are metaphorical descriptions of force and
command. For instance, in describing the downfall of the en-
emy, Zecharia said, “v’hasirosi… v’shikutzav mibein shinav,” “I will re-
move… [abhorrence] from between his teeth” (Zecharia 9:7), and
in Eicha, the wrath of the enemy is described as “vayacharku shen,”
“they gnash [their] teeth” (Eicha 2:16) [2].
Later references, including the Mishnah, along with its com-
mentary in the Gemara and works of Rishonim and Acharonim, give
more literal clues about dentistry and its development through
time. The Mishnah proclaimed, “A gold tooth, Rabbi Meir permits
[wearing outside on the Sabbath] and the Sages forbid” (Shabbos 6)
[3]. Why did some Rabbis prohibit wearing a gold tooth outside
on Shabbos? Rashi (Shabbos 65a) cited the opinion of his teachers
who said that a person who wears a gold tooth in public may be-
come embarrassed because a gold tooth clearly does not resemble
the other teeth. Therefore the person might remove the tooth
30 Derech HaTeva
View of Judaic
while not within an eruv and violate the prohibition of carrying
[4]. The Avnei Nezer added an additional reason why gold teeth
would embarrass a person: he noted that false teeth were very rare
at that time and a person would not want to be seen with some-
thing so uncommon [5].
Rashi, however, disagreed with the reasoning of his teach-
ers and stated that the person will eventually carry the tooth on
Shabbos because he will be proud of the expensive prosthesis and
will remove it to show it to others. The Maharsha offered sup-
There is a beraisa which stated that R’
Yishmael bought his niece a gold tooth
to enhance her appearance. Clearly,
gold teeth were valued as a cosmetic
enhancement at that time.
port for Rashi’s opinion: there is a beraisa which stated that R’
Yishmael bought his niece a gold tooth to enhance her appearance.
Clearly, gold teeth were valued as a cosmetic enhancement at that
time. The Ben Ish Chai reconciled the disagreement between Rashi
and his teachers by distinguishing between yellow gold and white
gold. He viewed yellow gold as conspicuous and embarrassing,
but stated that white gold was beautiful and a person was likely to
remove and display a white gold tooth [4].
The Mishnah continued to state that silver teeth were permit-
ted to be worn outside on Shabbos. According to Rashi’s teachers,
silver teeth were not as noticeable as gold teeth and were not em-
barrassing; according to Rashi, silver teeth were not as expensive
as gold teeth and were not worthy of display. From this halachic
debate, we learn that dental prosthetics during the times of the
Mishnah, Talmud and Rishonim were composed of several mate-
rials and even were removable. It is also interesting to note the
emotions linked to the various restorative materials at different
times: during the Talmudic era, gold teeth were valued, whereas
Rashi’s teachers viewed them as unsightly and embarrassing [4].
 The Gemara is replete with references to methods used to
treat various dental ailments. In Kiddushin, it stated, “While drill-
ing (lachtor) the tooth, it falls out.” “Lachtor” means to drill, in-
dicating that dental drills were already being utilized in the time
of the Gemara [3]. It is interesting to note that while drilling was
discussed as early as the Gemara period, the use of modern drills
is a relatively recent development. Drills are commonly used in
dentistry to remove caries, or decay, from inside a tooth. Before
drills were invented, dentists resorted to toothpicks or scissors to
remove caries. In 1790, George Washington’s dentist invented
a drill that rotated through use of a pedal, and in 1838 a “hand-
cranked” drill was patented. Drills that operate with motors were
not used until the 1860’s. Today, mechanical drills rotate up to
400,000 rpm and are used to very accurately and smoothly shape
teeth for crowns and fillings, with minimal discomfort to the pa-
tient [6].
Rashi, however, did not translate “lachtor” as “to drill,” but
commented that “lachtor” suggested a method to ‘cleanse the
base of the tooth.’ Rashi described a scaling method, a procedure
analogous to one still used today to treat periodontal disease [7].
Periodontal disease involves infection of the periodontium, the
tissues around the teeth below the gumline, and can lead to bone
and tooth loss. It is generally caused by accumulation of bacteria-
laden debris beneath the gumline, which eventually forms calcu-
lus, or tartar, when exposed to the natural minerals of the mouth.
A scaling procedure utilizes vibrating hand instruments to clean
debris from below the gums. Scaling is usually performed with
a procedure called root planing, which smoothes the root of the
tooth to remove irregularities which could likely become the loca-
tion of future buildup of bacteria [8]. Even in the times of the
Gemara similar procedures were performed, as it said in Kidushin,
“Scraping is a means of cleaning the teeth” [9].
The Gemara provided even greater insight into ancient den-
tistry. It described the use of wood, in addition to gold and silver,
to replace teeth. In Shabbos 6:8c of the Talmud Yerushalmi, a story
of a woman revisiting a “nagra,” a carpenter, to replace her tooth,
was discussed [2]. Toothpicks were used to clean and align teeth
(Tosefta Shabbos 5:1). In Chullin (16b) it stated, ‘A reed should not
be used for this purpose because it may injure the gums’ [10]. In
D’mai, a story is told of Rabbi Shimon ben Cahana and Rabbi Ela-
zar walking together, when one asked the other, ‘Bring me a twig
from the hedge to pick my teeth’ [11]. Extractions were also per-
formed, but they were considered dangerous surgical procedures,
as Rav warned his son not to have his tooth pulled (Pesachim 113a)
[10].
The Rambam offered much information about dental ailments
and remedies. He described a gold tooth placed “on top of a
black or red one.” A nonvital tooth becomes blackened when the
dentin layer is discolored by degraded blood cells, and a tooth may
appear red when the outermost layer of enamel remains healthy
but the internal pulp decayed [3]. Rav Ovadiah MiBartenura, how-
ever, described teeth “with a changed appearance due to mold”
[7]. Today we know that tooth decay, or dental caries, is a disease
which affects vital teeth only. It is caused when bacteria, attracted
to sugars on the teeth, ferment the carbohydrates into organic
acids. The acids, formed on the outer surface of the tooth, or
enamel, travel via tubules to the inner layers of the tooth, dentin
and pulp. Using aniline dye, Dr. G.V. Black detected tubules with
greatly enlarged diameters, as a result of bacteria traveling to the
inner layers of the tooth [12].
In Regimen of Health, the Rambam listed several remedies for
a toothache, among them cinnamon bark, coriander, vinegar, and
raisins [10]. The oral health benefits of raisins have been scien-
tifically proven just recently, centuries after the Rambam suggested
raisins as a cure for toothaches! Dr. C.D. Wu at the College of
Dentistry of the University of Illinois researched the possible
contribution of raisins to oral health. By utilizing antimicrobial
assay-guided fractionation and purification technique, compounds
in raisins such as oleanolic aldehyde, linolenic acid, betulinic acid,
and beta-sitosterol glucoside were found to prevent the growth
of oral pathogens. These antimicrobial phytochemicals inhibited
bacteria which cause caries and periodontitis. In addition, the
proanthocyanidins in grape seed extract were found to aid in the
reduction of root caries [13].
The importance of oral health to the general health of the
body has been known for centuries, as the Yalkut Shimoni described,
“The health of the body depends on the teeth” [9]. However, re-
cent scientific studies are beginning to prove more conclusively
the link between oral health and general health. Drs. Kaneko,
Yoshihara, and Miyazaki found a positive correlation between the
number of sites of root caries and C-reactive protein serum levels.
Higher levels of this protein indicated an elevated risk of cardiac
dysrhythmia and cardiovascular disease [14]. In addition, a study
on Pima Indians with diabetes concluded that periodontal disease
caused an increase in the number of diabetic complications due
to increased blood sugar levels. When the periodontal disease was
controlled, the diabetic complications decreased markedly [15].
The advances in dentistry today would not have been possible
without building on the knowledge and achievements of previous
Derech HaTeva 31
generations. One particularly interesting modern development in
dentistry is the use of dental stem cells to regenerate lost tooth
and bone structure. Dental pulp stem cells, or DPSCs, are ca-
pable of renewal and differentiation, and studies have shown that
DPSCs can form dentin, pulp, bone tissue, and crown structures
[16].
In addition to DPSCs, other types of dental stems cells have
been researched. Drs. Park, Jeon, and Choung obtained DPSCs,
periodontal ligament stem cells (PDLSCs) and periapical follicu-
lar stem cells (PAFSCs) from molars of beagle dogs and allowed
these cells to regenerate. PDLSCs were found to be the most
effective in regenerating alveolar bone, cementum, nerves, blood
vessels, and periodontal ligaments [17]. Mesenchymal stromal
cells (MSCs) extracted from third molars were also utilized to
derive stem cells. Through retroviral transduction of three tran-
scription factors (OCT3/4, SOX2, KLF4), induced pluripotent
stem cells, which were similar to human embryonic stem cells,
were formed from MSCs [18]. Exfoliated deciduous teeth, or
“baby teeth” may also prove to be a promising source of stem
cells (SHEDs) which can regenerate tissues. Dental pulp was re-
moved from deciduous teeth, and SHEDs were cultivated in cell
culture medium. Analysis of these cells revealed that SHEDs did
not degenerate in long-term experimentation [19]. Therefore,
banking of exfoliated deciduous teeth may become popular in
the future, as this method of storing a person’s own stem cells
would be an effective and painless way to eliminate risk of im-
mune rejection [20].
From the timeless verses of the Torah, through the palpable
conversations in the Gemara and analyses of the commentators,
we have traced references to dentistry throughout our history. By
learning how our ancestors related to this field and how it has
changed, we can gain a new appreciation for the development of
modern dentistry and the contributions of our religious sources
to this science. g

Acknowledgements
I would like to express heartfelt appreciation to my parents for your continuous support, for providing me with a superior education, and for being my role
models through your constant acts of chesed. Thank you to Dr. Babich for all your help and guidance in writing this article and producing this volume of
Derech HaTeva. Thank you for the many opportunities you have given me in Stern to learn, to give, and to grow. I will forever be inspired by your generos-
ity, dedication, and concern for your students. Thank you to Rabbi Laibel Schapiro for editing this article for its Torah content.

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